Provider Demographics
NPI:1225419740
Name:M.G.D. ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:M.G.D. ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DESIGNEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERLINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-644-0627
Mailing Address - Street 1:243 KLEVIN ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2149
Mailing Address - Country:US
Mailing Address - Phone:907-644-0627
Mailing Address - Fax:907-868-2589
Practice Address - Street 1:243 KLEVIN ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2149
Practice Address - Country:US
Practice Address - Phone:907-644-0627
Practice Address - Fax:907-868-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1011013104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness